The Medicaid piece

Margot Sanger-Katz’s headline pretty much gets it, “Shifting Dollars From Poor to Rich Is a Key Part of the Senate Health Bill.” And, the biggest way this shift happens is cutting Medicaid. Of course, many people don’t realize how vital Medicaid is to so many Americans and so many aspects of American health care. Sanger-Katz has another Upshot piece on that. Here’s the key chart.

Then there’s Medicaid, the bill’s most prominent target for assault. It also not only eliminates the ACA’s expansion of Medicaid, phasing it out beginning in 2021, but goes much farther. Medicaid would no longer be an “entitlement,” which means that anyone who meets the eligibility criteria gets the benefit, even if in some years that means its budget gets unexpectedly bigger. Instead, Medicaid would be subject to new, slow-growing per capita caps, which represents hundreds of billions in cuts in coming years. In addition, states would be given “flexibility” over whom they cover, meaning they’d be allowed to reduce benefits or kick people off the program entirely. And who are the beneficiaries of Medicaid? The poor, the disabled, and the elderly (even though they get coverage through Medicare, Medicaid pays for a large portion of the country’s nursing home expenses). These are the people to whom the GOP is showing the back of its hand so it can offer a large tax cut to the rich…

What does it say about the values and priorities of the people who wrote this bill, and the people who will vote for it? It says that they are deeply concerned about maximizing the wealth of the wealthy — so concerned, in fact, that they’re willing to take away health coverage from millions of people in order to provide the wealthy a large tax cut. It says that they think that poor people have it too easy. It says that they believe health care is a privilege, not a right — if you can afford it, good for you, but if you can’t, too damn bad. And it says that their vision of America’s health-care future is one that is surpassingly cruel, where alone among the world’s industrialized democracies, we’ll intentionally leave millions of our citizens without health coverage and allow them to be bankrupted by medical bills. [emphasis mine]

And Greg Sargent on how the Republicans’ successful news hack has allowed these giant Medicaid cuts to go largely unnoticed:

The single most glaring feature of the Republican health-care plan is how massively regressive it is. Whether in the Senate or House version, it cuts health-care spending on poor people by hundreds of billions of dollars, to finance (relative to current law) an enormous tax cut for the rich. The regressiveness of the plan is a feature, not a bug. Even if you allow that Republicans believe in a principled way that this will benefit America, it is the plan’s overriding ideological goal. Cutting spending on the poor to facilitate a huge tax cut for the rich, in many ways, is the plan.

But what if a large majority of Americans don’t have a clear sense that the plan even does this? A new Kaiser Family Foundation poll out today suggests this may be the case, which hints at a number of troubling things about where this debate is headed next.

The Kaiser poll finds that only 38 percent of Americans know that the GOP plan makes “major reductions” in Medicaid spending. Another 27 percent say it makes “minor” reductions; 13 percent say it makes no reductions; and 20 percent say they don’t know. If this polling is right, that means at least 6 in 10 Americans are unaware of the central feature of the GOP plan to reconfigure one-sixth of the U.S. economy, one that will impact many millions of people over time…

At the same time, though, the poll finds that the public broadly approves of Medicaid as it is and supports continued spending on it — and that very few Americans support the GOP cuts when asked. Sixty-one percent of Americans say that Medicaid is “working well” for most low-income people it covers. But only 36 percent support cutting funding for Obamacare’s Medicaid expansion; and only 35 percent support changing Medicaid’s funding to limit how much states get each year. The GOP plan phases out the Medicaid expansion and uses per-capita caps to limit payments to states, in what could shape up as a dramatic overhaul of Medicaid well beyond ending the expansion, resulting in deep cuts to the program’s assistance to poor children, people with disabilities and the sick.

But, will Americans vote based on this in coming years? Sadly, I fear too few of them will, as such cuts will be forgotten when you can scare too many Americans with all those scary immigrants and Muslims coming to ruin our country.